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Payer/Employer's Details

Payer/Employer's Name and Address: AMAZON COM SERVICES LLC,

PO BOX 80726
SEATTLE, WA 98108-0726
(272) 900-5968

Payer/Employer's TIN: EIN: 82-0544687

 Recipient List

1. ANDERSON BATISTA HOLGUIN

 a Employee’s social security number For Official Use Only
VOID
XXX-XX-2892 OMB No. 1545-0008

b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
82-0544687 $70270.00 $3654.04
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
AMAZON COM SERVICES LLC $70270.00 $4356.74
PO BOX 80726
5 Medicare wages and tips 6 Medicare tax withheld
SEATTLE, WA 98108-0726
$70270.00 $1018.91
7 Social security tips 8 Allocated tips
$0.00 $0.00
d Control number 9 10 Dependent care benefits
269723 LOS2/MD2 $0.00
e Employee’s first name and initial Last name Suff.
11 Nonqualified plans 12a See instructions for box 12
C
ANDERSON BATISTA HOLGUIN $0.00 o $816.00
d
e
DD

13 Statutory
employee
Retirement
plan
Third-party sick
pay 12b
C
o
d
$0.00
127 SAINT JAMES SAT e

SCHUYKILL HAVEN, PA 17972 14 Other 12c

C
o
d
$0.00
e

12d
C
o
d
$0.00
e

f Employee’s address and ZIP code

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc 19 Local income tax 20 Locality name

PA 20101968 $70270.00 $2108.10 $70270.00 $702.70 540501

W-2
Department of the Treasury - Internal Revenue Service
Form Wage and Tax Statement For Privacy Act and Paperwork Reduction
Act Notice, see separate instructions.
Copy A—For Social Security Administration. Send this entire page with Cat. No. 10134D
Form W-3 to the Social Security Administration; photocopies are not acceptable.

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Draft - For review purpose only.

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